Sun-Herald senior writer

Kim Forrester with her daughter Sarah, who has been diagnosed with ADHD. Photo: Wolter Peeters

About one in 10 Australian children has attention deficit hyperactivity disorder, with more diagnosed and medicated every year.

Yet what if none of them actually has ADHD? What if their inability to pay attention and their impulsive behaviour actually masks an undiagnosed and untreated condition? What if we're drugging our children for something that doesn't exist?

That's what Chicago doctor Richard Saul argues in his deliberately controversial book ADHD Does Not Exist.

He believes patients are likely to suffer from other conditions - such as poor eyesight, sleep deprivation, bipolar or learning difficulties - of which ADHD is merely symptomatic. He argues that once these underlying conditions are found and treated, the ADHD symptoms ''almost always go away''.

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Australian doctors have branded Saul's claims ''dangerous'' and ''sensationalist'', saying there is a wealth of evidence that ADHD does exist. They say doctors here are far more cautious in its diagnosis and treatment than in the US.

''He's saying, 'My personal experience outweighs all the scientific evidence available to people, my information is going to be more persuasive because it creates fear and concern,''' says Sydney University's Associate Professor Michael Kohn, a staff specialist at the Children's Hospital at Westmead who has worked with ADHD children for two decades.

Yet some parents believe any exploration of what causes ADHD symptoms is helpful. ''I'm pleased they're continuing to look at and question the diagnoses that are going on,'' says Kim Forrester, whose son Daniel has ADD and daughter Sarah has ADHD.

A child who has difficulty paying attention, struggles to follow instructions, is disorganised and forgetful, can't sit still, doesn't like waiting, and talks non-stop, can be classified as having ADHD. In 1937, it was discovered stimulant drugs helped control this behaviour.

But according to Dr Saul, who has worked in behavioural neurology and development for 50 years, there has been a ''staggering'' rise in ADHD diagnoses this century.

''The ADHD diagnosis has become far too large and all-encompassing, resulting in too many people suffering from stimulant use and the delay or denial of the treatment that's actually right for them,'' he says. In Australia, estimates of the prevalence of ADHD in school-age children ranges from 3 per cent to 11 per cent.

In a bid to stop the ''knee-jerk'' diagnosis of ADHD, Dr Saul has identified more than 20 alternative causes of ADHD symptoms.

He cites multiple case studies of patients who have come to see him claiming to suffer ADHD, only to be subsequently diagnosed with a completely different condition.

There is seven-year-old Aviva who is causing trouble in class, fidgeting, talking loudly, and always asking to go to the toilet. A paediatrician has diagnosed ADHD and put Aviva on medication, to which she is reacting badly. Saul opts for tests that reveal Aviva suffers from near-sightedness. She gets glasses and her behaviour immediately improves.

Nine-year-old Bhavik is also disruptive in class and his teacher suspects ADHD. His behaviour is not a problem outside school, he is a top academic performer, and he tells Dr Saul he always feels bored in class. Dr Saul sends him for IQ testing. It reveals he's in the top 2 per cent of students, classifying him as gifted.

But Professor Kohn says the way Dr Saul advocates assessing ADHD symptoms is ''routine'' in Australia. To be diagnosed here, children must display inattention and/or hyperactivity symptoms for at least six months, according to the National Health and Medical Research Council clinical practice guidelines.

The symptoms must have been present since early childhood, and must affect their behaviour at school, at home or socially. Significantly in the context of Dr Saul's argument, there must also be ''no better alternative explanation''.

Doctors prescribe stimulants such as Ritalin for ADHD sufferers to increase their attention span and reduce their impulsiveness. Prescriptions for Ritalin and other drugs to treat ADHD rose 72 per cent in Australia between 2000 and 2011, a study published in the British Medical Journal found.

Ms Forrester delayed putting her son on medication for two years after he was diagnosed with ADD. She noticed when Daniel was two he was always on the go, constantly asking questions and interrupting people, but it wasn't until he started school did she realise that it marked him out from other children.

Daniel's year 3 teacher suggested his parents get him tested, and he was diagnosed with ADD. He started Ritalin when he began high school.

Ms Forrester says Daniel loves the change Ritalin made. ''Personality-wise, he was absolutely still my son, but I saw he was much more focused. Socially he became more active and more accepted, and his teachers gave him glowing reports.''

Now Ms Forrester is considering whether to put her daughter on medication, as she has just been diagnosed with ADHD. ''I've suspected it for some years,'' she said. Ms Forrester wants the medical profession to explore Dr Saul's theories. ''At the end of the day it's about the child … The rest of it is secondary.''